Medical vs. Vision InsuranceOne of the most challenging billing issues in an ophthalmology office is whether we should be billing the medical or vision plan.
An ophthalmologist is a medical doctor (just like your family doctor or cardiologist) and provides very comprehensive, medical eye exams. However, ophthalmologists also provide routine vision exams for people with no eye disorders.
For Patients with BOTH Medical and Vision CoverageYour vision insurance is intended to provide you with a baseline eye exam. If you are being evaluated for medical reasons (corneal disorders, diabetes, cataracts, glaucoma suspect, double vision, etc.), you are being provided with medical care. Typically your vision company does not provide coverage for medical care. Therefore, we will file a claim with your medical insurance for visits related to medical complaints and problems. (If we are participating in your vision plan, your exam will be filed as a secondary claim to your vision plan after your medical plan completes the claim.)
For Patients without Vision CoverageIf you are being seen for a routine eye exam and do not have vision coverage, your medical insurance will not pay for the exam. However, if you have a medical problem (corneal disorders, diabetes, a lazy eye, cataracts, glaucoma suspect, double vision, etc.), your visit is considered a medical problem and can be billed to your medical plan.
Please be aware that many medical plans are no longer paying for eye exams because of a diagnosis of blurred vision or a headache. They are considering this a routine vision exam and are often not paying for the exam.
Our billers will determine the appropriate plan (medical or vision) to file your claim, based on the results of your exam.
When your visit is for a routine eye evaluation, we collect the total fee at the time of service unless we participate with your vision plan. If we are participating (with your vision plan), we will follow your plan's guidelines collecting applicable copay and/or co-insurance at the time of service.